Provider Demographics
NPI:1063394716
Name:PROFOUND WOUND SPECIALISTS INC
Entity type:Organization
Organization Name:PROFOUND WOUND SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDRANIK
Authorized Official - Middle Name:
Authorized Official - Last Name:GEVORKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-885-9888
Mailing Address - Street 1:11145 TAMPA AVE STE 27A
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2274
Mailing Address - Country:US
Mailing Address - Phone:818-717-7181
Mailing Address - Fax:
Practice Address - Street 1:11145 TAMPA AVE STE 27A
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-2274
Practice Address - Country:US
Practice Address - Phone:818-717-7181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center